Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 200301068 | NC |
NPI | 1083685663 |
---|---|
Provider Name | Dr. Julie Trainer Tiffany |
First Address | Raleigh, NC 27607-6678 |
Second Address | Raleigh, NC 27607-6678 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 08/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
135MP | BLUECROSSBLUESHIELD INS # (01) | NC |
89135MP | (05) | NC |
H34671 | (02) | NC |